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BERWICK AREA HEART SUPPORT GROUP
JANUARY ~ FEBRUARY 2009 NEWSLETTER
Berwick Area Heart Support Groups next meeting is Wednesday February 4th 2009 at the DayHospital Berwick Infirmary from 7.00pm – 9.00pm, the guest speaker is Anna Wood, Modern Matron at Berwick Infirmary.
“Supporting people who live with long term conditions –
patient-centeredness is not enough”
I received an invitation, at short notice, for one of our group to represent people with vascular problems at a seminar in London organised by the Health Foundation Charity on the 11th/12th December. Phil was able to attend the seminar and will give a report at the next meeting
Purpose of the event
Despite an enormous amount of effort to support people (especially those with LTC Long Term Conditions) the data shows that less than 50% of those who live with LTCs feel involved by professionals in making decisions about their healthcare and supported to self care / self manage effectively . This figure is unacceptable and has not changed over 5 years. The aim of the event is to explore this issue, identify some of the root causes, the barriers and challenges as a basis of moving forward to more practical solutions.
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Faith in ourselves
Dr Higham was our speaker in December and came bearing£500 as a grant from a Trust Fund. He has been our Honorary President since our start in 2001, and, goodness knows how, has found the time to come to see us at least once and often twice a year. His help and faith in us have been much appreciated. He would now like our help. Changes have been made, and continue to be made in the hospital based services, and he would like to consult us on up-coming changes. He said that it is clear that patient involvement improves outcomes. Cardiology in Northumberland has already met set targets and improved on them. Heart attacks (MI) are managed differently now. Twenty years ago there was serious risk especially for those over 75, following MI. This risk has been reduced from around 20% to the more recent1%. The swiftest and more secure procedure is now to deliver the patient straight to the Freemans for the insertion of a stent, and Dr Higham is very pleased with results. He now wants to consider the best ways to deliver rehab after the two day stay in the Freemans. He would like a ‘Patient Panel’ to include us and to consult on this and other matters including the delivery of cardio services to Berwick. He said patients should consider the proposals before any new scheme is started.
Dr H then gave us a brief update on the CAT scan technique for looking at 3D images of the heart and its arteries. This amazing technique uses Xrays, but the risk from the radiation is much reduced, and compares favourably with the invasive angiogram. The information that he can see in the images is different from that obtained .by angiograms and other techniques, but is particularly useful for seeing calcification (‘hardening’) that is characteristic of progressive arterial disease. (The bright white slivers were very obvious in the images he showed us). Similarly in the case of heart failure, –that is the inability of the heart to move enough blood, especially in response to exercise – , the CAT scan can see whether symptoms are due to coronary artery disease or not. A number of heart failure patients do not have coronary artery problems.. The CAT scan is useful also for providing pre-op information, but perhaps the most frequent use has been to assess the health of grafts one year on from by-pass surgery.
We look forward to being able to help Dr Higham with the Patient Panel and to his next visit, and will report to him our continuing progress in reaching out to heart patients and those at risk in our area. Thanks again Dr Higham. Your support strengthens our faith in ourselves.
Cardiac Nurses
We also welcomed at the December meeting, Nurse April Long, who takes the lead for Cardiac Nurses in our area. Thanks April for contacting and supporting us.
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Risk
This is the first of a short series reminding us about the risks of getting serious disease and or of suffering chronic disability from disease.
We often see information that tells us that risk (of illness / sudden death) is increased or decreased, by a particular medicine or activity. For example, even low levels of drinking alcohol are not ‘safe’ because they are associated with increased risk of a cancer of around 20% (percent). However, this kind of risk is spread over a long period, and other risks may actually be more important. The number of people, who share our lifestyle and who end up with a particular cancer or, as in our case, with arterial disease, is a better indicator. For example, when we see an increasing proportion of people get Type II diabetes and that these as a group, subsequently end up with 2 to 4 times the number of heart attacks compared with the ordinary population, we know this is a serious risk to be tackled using both medicine and lifestyle change. Similarly, there are a substantial number of us who will get one of the major cancers. We can take note that some countries have 20 or more times the risk of colon cancer than other countries. Lifestyle is very important in the long term.
Risk and Heart disease(s)
For those of us with a heart or artery condition, any improvement in risk factors is worth having, because taken together, these improvements can dramatically reduce both our immediate risks and reduce the risk of our disease going any further, and importantly, can reduce our present and future disability.
We are all aware of the ‘classical risk factors’ for coronary artery (CAD) and associated heart disease (not forgetting stroke and peripheral artery disease, including leg artery problems). Age increases both the risk of artery disease and the risks that arise as the disease worsens. Genetics or family pre-disposition can also make individuals more vulnerable.
The risks particularly associated with ‘lifestyle’ show up as, or are related to:
- Blood lipids out-of-order (not just ‘cholesterol’, but all parts of the system that distributes fat around the body)
- Diet; especially a lot too much saturated fat from meat and dairy products, trans-fats from processed food’, sugar and processed starchy foods, salt
- Lack of exercise
- Overweight
- Other very ‘risky disorders are often associated with the above, especially with being overweight and with eating salty and sugary foods (including white bread and pastry), and with lack of exercise:
- Hypertension (‘blood pressure’)
- Diabetes (both types rapidly multiply the risk from CAD, but Type II diabetes that often develops in middle-age because of poor lifestyle, can often be reversed or slowed down by improving your physical health)
- Inflammation (general / systemic inflammation that can be exacerbated by diet, obesity, or even chronic infection such as serious gum disease).
A special place is reserved for smoking, active or passive, because as well as insulting the arteries every time you smoke, it risks triggering, anytime, a heart attack in anybody with existing artery problems. Similarly, poor air quality, ‘fumes’, are dangerous for heart disease.
Statins reduce the risk of heart attack or other symptoms by improving both cholesterol (and the proper function of blood lipids) and reducing inflammation. Recent work suggests that the large majority (perhaps 80 percent) of people in our ‘advanced’ / ‘western’ countries over the ages 50 to 60 would benefit from taking a statin. This seems to confirm that in countries similar to ours, underlying arterial problems become the norm rather than the exception. The almost instant benefits of the smoking ban likewise suggest that many dodgy arteries now survive that would previously have suffered an acute event; although the owners were not aware, and presumably are still not aware that they have a problem.
Support: There is also some accumulating evidence that mutual support dealing with anxiety helps preserve us from the worst effects of arterial disease. More of that another time … but see also below.
The next article in this short series will say more about cancer. The same changes in lifestyle that help artery diseases, also significantly reduce the risk of getting many cancers. It is clear that in our so-called advanced culture, while we pride ourselves on our modern hygienic ‘safety’ and ‘health services’, we actually generate most of the ill-health of middle and older years, arterial disease and most major cancers. A recent estimate suggests, for example, that perhaps 96% of prostate cancer arises from lifelong dietary habits. The good news is that that a different dietary and exercise lifestyle that lowers the risks from arterial disease also will seriously improve risks of getting many of the ‘big number’ cancers. Similarly, smokingcontributes generally to cancer, not just lung cancer, and this seems to have been considerably under estimated until recently. We will need also to take a further look at cancer and other risks related to alcohol.
Best hopes for better lifestyle, and lives … to be continued …
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Recipe of the month
“Ann’s Fat-Free Fruit Cake”.
Sugar Warning: use sparingly.)
Oven setting to 375 degF, 170degC
Use non-stick 2 lb loaf tin or 6 inch cake tin, base-lined with siliconised baking parchment, or fully-lined for a non-stick tin.
Ingredients
- 7oz self-raising flour
- 1 lb dried mixed fruit (currants, raisins, sultanas)
- 1 tsp ground mixed spice
- 2 oz soft brown sugar
- 4 tablesp powdered dry skim-milk
- 1 tablesp marmalade or apricot jam
- 1 tsp molasses or black treacle
- 1 cup stewed pureed apple
- 2 egg whites, whisked until frothy but not stiff
- 5-7 tablesp liquid skimmed milk
Method
- Mix all ingredients in the order listed above until ‘soft-dropping’ consistency:
- adjusting amount of milk to give required consistency.
- Bake for approx. 40 min, until firm.
ALTERNATIVE slight OIL VERSION
- Substitute egg whites.
- Use 2 oz of stoned dates and 2 tsp sunflower oil
- (Soak dates for 15 min then add oil & either blend in electric blender or beat with a fork until smooth.)
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Depression and Heart Disease
A fact sheet that summarizes what heart disease patients need to know about depression.
- Persistent sad, anxious, or "empty" mood
- Feelings of hopelessness, pessimism
- Feelings of guilt, worthlessness, helplessness
- Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
- Decreased energy, fatigue, being "slowed down"
- Difficulty concentrating, remembering, making decisions
- Insomnia, early-morning awakening, or oversleeping
- Appetite and/or weight changes
- Thoughts of death or suicide, or suicide attempts
- Restlessness, irritability
If five or more of these symptoms are present every day for at least two weeks and interfere with routine daily activities such as work, self-care, and childcare or social life, seek an evaluation for depression.
Introduction
Depression can strike anyone. However, research over the past two decades has shown that people with heart disease are more likely to suffer from depression than otherwise healthy people, and conversely, that people with depression are at greater risk for developing heart disease. Depression may make it harder to take the medications needed and to carry out the treatment for heart disease. Treatment for depression helps people manage both diseases, thus enhancing survival and quality of life.
Depression and anxiety disorders may affect heart rhythms, increase blood pressure, and alter blood clotting. They can also lead to elevated insulin and cholesterol levels. These risk factors, with obesity, form a group of signs and symptoms that often serve as both a predictor of and a response to heart disease. Furthermore, depression or anxiety may result in chronically elevated levels of stress hormones, such as cortisol and adrenaline. As high levels of stress hormones are signalling a "fight or flight" reaction, the body's metabolism is diverted away from the type of tissue repair needed in heart disease.
Despite the enormous advances in brain research in the past 20 years, depression often goes undiagnosed and untreated. Persons with heart disease, their families and friends, and even their physicians and cardiologists (physicians specializing in heart disease treatment) may misinterpret depression's warning signs, mistaking them for inevitable accompaniments to heart disease. Symptoms of depression may overlap with those of heart disease and other physical illnesses. However, skilled health professionals will recognize the symptoms of depression and inquire about their duration and severity, diagnose the disorder, and suggest appropriate treatment.
Depression Facts
Depression is a serious medical condition that affects thoughts, feelings, and the ability to function in everyday life.
Depression results from abnormal functioning of the brain. The causes of depression are currently a matter of intense research. An interaction between genetic predisposition and life history appear to determine a person's level of risk. Episodes of depression may then be triggered by stress, difficult life events, side effects of medications, or other environmental factors. Whatever its origins, depression can limit the energy needed to keep focused on treatment for other disorders, such as heart disease.
Get Treatment for Depression
Effective treatment for depression is extremely important, as the combination of depression and heart disease is associated with increased sickness. Prescription antidepressant medications, particularly the selective serotonin reuptake inhibitors, are generally well-tolerated and safe for people with heart disease. There are, however, possible interactions among certain medications and side effects that require careful monitoring. Therefore, people being treated for heart disease who develop depression, as well as people in treatment for depression who subsequently develop heart disease, should make sure to tell any physician they visit about the full range of medications they are taking.
Exercise is another potential pathway to reducing both depression and risk of heart disease. A recent study found that participation in an exercise training program was comparable to treatment with an antidepressant medication (a selective serotonin reuptake inhibitor) for improving depressive symptoms in older adults diagnosed with major depression. Exercise, of course, is a major protective factor against heart disease as well.
Use of herbal supplements of any kind should be discussed with a physician before they are tried. Recently, for example, scientists have discovered that St. John's Wort, an herbal remedy sold over-the-counter and promoted as a treatment for mild depression, can have harmful interactions with some other medications.
Treatment for depression in the context of heart disease should be managed by a mental health professional-for example, a psychiatrist, psychologist, or clinical social worker-who is in close communication with the physician providing the heart disease treatment. This is especially important when antidepressant medication is needed or prescribed, so that potentially harmful drug interactions can be avoided. In some cases, a mental health professional that specializes in treating individuals with depression and co-occurring physical illnesses such as heart disease may be available.
While there are many different treatments for depression, they must be carefully chosen by a trained professional based on the circumstances of the person and family. Recovery from depression takes time. Medications for depression can take several weeks to work and may need to be combined with ongoing psychotherapy. Not everyone responds to treatment in the same way. Prescriptions and dosing may need to be adjusted. No matter how advanced the heart disease, however, the person does not have to suffer from depression. Treatment can be effective.
Remember, depression is a treatable disorder of the brain. Depression can be treated in addition to whatever other illnesses a person might have, including heart disease. If you think you may be depressed or know someone who is, don't lose hope. Seek help for depression.
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Wallys Yarn
Husband and wife are shopping in Tesco's when the man picks up a crate of Stella and sticks them into the trolley
'What do you think you're doing?' asks the wife 'They're on offer, only £10 for 24 cans', he says
'Put them back. We can't afford it,' says the wife and they carry on shopping...
A few aisles later the woman picks up a £20 jar of face cream and sticks it into the trolley.
'What do you think you're doing?' asks the man, 'It's my face cream. It makes me look beautiful,' she says.
The man replies... 'SO DOES 24 CANS OF STELLA AND IT'S HALF THE PRICE'
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